What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior?
Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)

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Friday, December 12, 2008

Medical Bloopers: A Medical Communication Defect

The problem with these hospital chart bloopers is that they represent a failing on the part of medical students or even physicians who write notes in the chart. The failing is, either because of lack of time or interest, what is written is not read by the writer after the pen touches the paper. What I keep teaching my medical students about their write-ups is to read, read, and re-read what they have just written but to read their statements as some ignorant reader who has no knowledge regarding the clinical situation and decide whether they understand what was written and whether the words make sense. Ambiguous comments in the chart may be funny to read, as many of the statements below, but their presence represents a defect in the communication system and, in some case, may lead to misinterpretation and harm to the patient.

(By the way, I had already put up Bloopers 1-19 on a thread back on June 28, 2005.But they are fun to read so in case a visitor missed those, I republished them today but with 6 more that I found.) ..Maurice.

1. The patient refused autopsy.

2. The patient has no previous history of suicides.

3. Patient has left white blood cells at another hospital.

4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night.

5. Patient has chest pain if she lies on her left side for over a year.

6. On the second day the knee was better and on the third day it disappeared.

7. The patient is tearful and crying constantly. She also appears to be depressed.

Most of these sound like transcription errors with failure to proof read carefully, not original statements hand written by the physician or student.As long as the intent was clear, they're a good source of humor and not a danger to anyone.

Joel, although I really have no idea where these examples came from, I can tell you that those of us who teach medical students and review their patient write-ups would not be surprised by many of these examples.Students and physicians are responsible for everything they dictate or write even if it is transcribed by some other person.

I think that careful phrasing of every expression is essential for clinically important communication. Take for example, pertinent your own medical specialty, #5 "Patient has chest pain if she lies on her left side for over a year." I would disagree and say that this not a transcription error, and as with many, it is a failure in the original production of the expression. The reader has to reassemble the words since it is obviously unlikely that the patient was really lying on left side for over a year and then developing the chest pain. Wouldn't "For the past year, the patient experiences chest pain when she lies on her left side" provide immediately more clinically useful information?

Trust me, even if these examples are just "made up", they truly represent confusing expressions that do occasionally or perhaps more than occasionally appear in patient's records. ..Maurice.

This is fascinating. I work as a proofreader right now, and this is a good reminder of how important it is to always be vigilant about the way we communicate information.

One of the things I always try to remember is that the human brain will fill in gaps and correct errors on its own if you're not actively looking for possible errors. It's like those emails that go around every once in awhile with paragraphs that are missing all of the vowels. People can still read the entire paragraph, even though the vowels are missing ... because your brain assumes what should be there and fills it in.

These are some great examples of why all of us need to "proofread" our own work and watch how we communicate essential information. I'm glad you teach your medical students to be vigilant about it.

Joel, These may not repressent "a danger to anyone" but such bloopers disconcert patients and patient families and reflect carelessness in keeping records. Carelessness in medicine is always dangerous!

I didn't mean they shouldn't be proof read and corrected.But these bloopers would only rarely be seen by patients and relatives. They should be enjoyed and then corrected.But you'll never do away with all typos and bloopers.

Joel, communication is a critical part of medicine whether it is across the operating table or across the office desk or within a patient record. As chair of a hospital ethics committee, I can tell you that many of our consults all deal with inadequate or unthinking communication between healthcare provider and patient/family. How one writes can also reflect how one thinks and communicates to patients. For example, a physician who is too rushed to read what he or she has written will most likely be also rushed to sit down with the patient and family to discuss important medical issues and decisions. That is why I really try to emphasize to my students the need to take the time and care in reviewing what they have written before submitting a patient's write-up as complete.

Again, it's not ridiculous appearance of these examples I published (or similar ones) and whether or not they will be seen by the patient or family but they can be markers of how the student will handle issues in the future.. with confusion or with clarity. ..Maurice.

On obtaining records from Outside Hospital, it was found that our OB patient had had a "forceful delivery with a piezo proctotomy." After spending a few fruitless minutes on google, we decided that well-meaning transcriptionist meant to write "a forceps delivery with an episiotomy."

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